Factors Affecting Safe Patient Handling Behavior Among Critical Care Nurses

A nation wide, cross-sectional survey of 361 critical care U.S. registered nurses (RNs) revealed that they are exposed to a strikingly high level of workplace risk in relation to patient handling tasks. The recently published study conducted by University of California at San Francisco researchers found that among the RNs surveyed: 

• 74% said that they manually performed all patient lift and transfer tasks during a normal work shift
• 51% reported that no lift device and no lift team was available at their hospital
• 47% indicated that a lift device was available on their unit of which 59.9% said that the lift device was available always or most of the time
• 7% said that a lift team was available in their hospital

The questionnaire also revealed a significant prevalence of musculoskeletal (MS) symptoms among the critical care RNs.  Work-related low back, neck, and shoulder MS that occurred during the prior 12 months was reported by 61%, 44%, and 35% of the RNs.

Safe work behavior was most strongly associated with a good safety climate.  Also, strong social support, controlled commitment (meaning patient care tempered by personal safety), and working the day shift were all related to good patient handling practices.  Surprisingly, workplaces characterized by a higher effort-reward imbalance had safer work behavior.

The Bottom Line – How This Applies To Ergonomists
This survey equips the ergonomist with an appreciation of the risk exposure that persists for hospital RNs relative to patient handling tasks.  More importantly, the study provides a blueprint to follow for achieving safe work behavior.  A safety culture – an injury avoidance attitude generated through cooperative interaction by multiple sectors of an organization – was found to be the most important predictor of safe patient handling conduct.  The survey also indicated that work factors of social support and controlled commitment were also significant.  A program that follows these principles will likely achieve success.

Other Key Points
The survey found that the perception of MS injury risk, physical workload, and MS symptoms did not influence how patient handling was performed among RNs.

The study also pointed out background information that had been reported in other publications which included:

• Low back pain among nursing employees has an annual prevalence of between 26% and 75% internationally
• More than 10,000 U.S. RNs sustain occupational musculoskeletal injury/illness per year that lead to lost work days
• The Registered Nurse profession ranks among the top ten U. S. occupations for risk of work-related musculoskeletal injury/illness
• The major cause of musculoskeletal injury/illness among nurses is patient handling tasks
• Intensive care nurses have a back injury incidence rate of 14.2 cases per 100 full-time employees

Research Method
From the membership in the American Association of Critical Care Nurses, 1,000 subjects were randomly chosen from staff or charge nurses who were currently working in a hospital and performed patient handling tasks.  After receiving participation acceptance and applying exclusion criteria, the authors reduced the cohort to 361 volunteers.

A questionnaire was mailed to the 361 subjects.  The survey elicited responses involving:

• Demographics and job characteristics (e.g., age, gender, race, education, job title, work schedule)
• Workplace and organization factors (e.g., hospital type, hospital setting, availability of lift devices, safety climate)
• Physical work factors (e.g., frequency of patient handling tasks, Physical Workload Index Questionnaire was completed)
• Psychosocial work factors (measured by the Job Content Questionnaire and the Effort-Reward Imbalance Questionnaire – looking at topics such as decision latitude, social support, and job strain)
• Risk perception of musculoskeletal injury (measured by risk perception to self and risk perception to others)
• Musculoskeletal symptoms (e.g., pain, aching, stiffness, burning, numbness, or tingling in the low back, neck, or shoulders in the prior 12 months)
• Save work behavior (15 questions that involved the preparation phase before conducting a patient handling task and the body mechanics used while performing the patient handling task)

Analysis primarily looked for relationships between safe work behavior and workplace factors.

Access
This study can be acquired from the copyright holder at: http://onlinelibrary.wiley.com/doi/10.1002/ajim.20843/abstract.

Article Title: Factors Associated With Safe Patient Handling Behaviors Among Critical Care Nurses

Publication: American Journal of Industrial Medicine, 53:886-897, 2010

Authors: S-J Lee, J Faucett, M Gillen, N Krause, and L Landry

This article originally appeared in The Ergonomics Report™ on 2010-08-17.